Diabetes is an epidemic that can be prevented or delayed through changes in lifestyle behaviors such as physical activity and diet among at-risk individuals. Readily available clinical prediction rules can identify these elevated risk adults suitable for interventions to promote these lifestyle changes. Primary care is often the location for communication of this risk and initiation of these lifestyle interventions. Ineffective provider-patient risk communication inhibits patient understanding of risk, motivation and behavior change. Risk communication is a complex process that involves both cognitive and emotional responses to risk information. Furthermore, provider-patient interactions do not typically encourage a bi-directional flow of information and discussion. Creating a collaborative conversation between provider and patient and incorporating risk communication principles into discussions of risk is challenging and would benefit from a well-designed risk communication tool. The overall objective of this project is to develop and pilot test a new personalized diabetes risk communication tool (DiabetesTalk) designed to promote healthy lifestyle behaviors among adults at elevated risk for diabetes. The specific aims are to: (1) develop an effective tool for communicating personalized diabetes risk information to adults at-risk for diabetes (2) test the feasibility and preliminary impact on physical activity of a new personalized diabetes risk communication tool among adults at elevated risk for diabetes. Modeled on the principles of design-based research, the study will use an established tool development protocol directed by a multi-disciplinary panel to iteratively develop the tool. Videotaped clinical encounters will be conducted to observe the effect of the tool on real-time discussions of diabetes risk. Changes in knowledge, risk perception, and motivation will be used to evaluate the success of the tool development steps. A RCT of 60 at-risk adults will then test the preliminary efficacy of the new tool to increase physical activity and improve other diabetes prevention behaviors. This five-year project will allow Dr. Mann to develop skills in risk communication and behavioral trial conduct while generating pilot data and preparing him for an independent research career in translational diabetes prevention. The development of an effective, personalized diabetes risk communication tool promises to help providers and patients unlock the motivational potential of primary care based risk communication.